Ankle Arthrodesis Nail and Outrigger Assembly

ABSTRACT

An intramedullary fixation device having a distal section; a proximal section; a connecting member for adjustably securing the distal and proximal sections end to end along a longitudinal axis; means for securing the proximal section to a first bone; and means for securing the distal section to a least one different bone. The connecting member is rotated to provide compression across a bone arthrodesis site to be stabilized and fused. Also described is a method of utilizing the intramedullary fixation device with an outrigger assembly.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part from and claims priority toU.S. patent application Ser. No. 12/500,473, filed on Jul. 9, 2009,entitled “ANKLE ARTHRODESIS NAIL AND OUTRIGGER ASSEMBLY,” which claimspriority to U.S. Provisional Application No. 61/079,132, filed on Jul.9, 2008, entitled “ARTHRODESIS NAIL OUTRIGGER ASSEMBLY” and to U.S.Provisional Application No. 61/079,130 filed on Jul. 9, 2008, entitled“ANKLE ARTHRODESIS NAIL AND OUTRIGGER ASSEMBLY,” all of which areincorporated herein by reference in their entirety as if set forth infull.

FIELD OF THE EMBODIMENTS

Embodiments of the present invention relate to surgical and bone fusiondevices and systems in general, and more particularly to an improvedarthrodesis nail that enables the bone fusion site to be sufficientlycompression prior to fusion, and more particularly still tea an improvedoutrigger assembly and method for implanting an arthrodesis nail.

BACKGROUND

The lower limbs of the human body, namely the femur (thigh bone), thetibia (shinbone), and fibula, are designed to bear the weight of thebody and to provide the body with sufficient stability. The femurcourses medially from its proximal end connected to the hip bone to itsdistal end connected to the knee, placing the knee joints closer to thebody's center of gravity and thus giving the body better balance whilewalking or standing. The tibia and fibula, which are connected togetherby an interosseous membrane, extend in parallel from the knee to ankle,with the tibia being larger and located medially in relation to thefibula. The tibia articulates proximally with the femur, forming thehinge joint of the knee, and distally with the talus bone of the foot atthe ankle, and as such receives most of the body's weight and transmitsit to the foot, while the fibula, which articulates proximally anddistally with the lateral aspects of the tibia, is a non-weight bearingbone and generally provides stability for the ankle joint. The shaft ofthe tibia is generally triangular in cross section, and its distal endis blunt where it articulates with the talus. Situated medially to suchdistal tibia end is the medial malleolus, and a fibular notch isprovided on the lateral surface of the tibia opposite the medialmalleolus.

The foot skeleton is made up of the tarsus, metatarsus, and phalangesbones, with the tarsus bones forming the proximal or heel end of thefoot, the metatarsus bones forming the bases of the toes, and thephalanges being the toe bones. The tarsal bones include the talus,calcaneus, lateral cuboid, medial navicular, and medial, intermediate,and lateral cuneiform bones. The talus articulates with the tibia andfibula superiorly and is located on the upper surface of the calcaneusbone, which forms the heel and with the part that touches the ground thetuber calcanei, and such bones support most of the weight of the body,although some weight is distributed to the heads of the metatarsals bythe arching of the foot. In some patients the ankle joint orinterconnection of the lower end of the tibia, the fibula, and the talus(spaced apart by articular cartilage and held together by variousligaments) can become worn or injured due to a degenerative condition ordeformity, or a fracture, subluxation, or other traumatic event. Inorder to stabilize the ankle joint and control the often severe paincaused by such conditions, an arthrodesis procedure may be necessary tofuse and therefore permanently immobilize the ankle joint, fusing thedistal end of the tibia with the talus. Where both the tibi-talar andtalocalcaneal joints are damaged, such as in some patients having severeosteoporosis, the calcaneus bone will also be fused with the ankle. Suchtibiotalacalcaneal arthrodesis procedures today are typicallyaccomplished by permanent intramedullary nailing, wherein after theankle bone surfaces have been prepared a rigid nail or rod is insertedin a hole drilled upwardly through the calcaneus and talus bones andinto the medullary canal of the tibia. Screws are passed laterallythrough holes drilled in the tibia to hold the proximal end of the nailin place in the tibia, and into the nail through holes drilled in thecalcaneus and talus bones. A limitation of known intramedullary ortibio-calcaneal arthrodesis nailing systems is in obtaining sufficientcompression across the arthrodesis site so that a proper fusion isaccomplished.

Embodiments of the invention provide both an arthrodesis implant whichis simple, easy to install and effective, as well as an arthrodesisoutrigger assembly for use with such implant which is effective duringan arthrodesis operation for proper alignment and implantation of thearthrodesis implant.

Alternate embodiments also provide an arthrodesis implant which can berelatively easily implanted in the foot and ankle and quickly, easilyand effectively secured in place.

Alternate embodiments also provide an arthrodesis prosthesis which isformed in two main sections which are adjustably secured together by anintervening rotatable adapter effective from the bottom of thearthrodesis prosthesis to compress or place tension on the leg and anklebones to be fused.

Alternate embodiments also provide an arthrodesis implant which isformed in two main sections adjustably secured together by a centralrotating fitting which in combination with an external compression discare used to provide tension from and through the foot bone to providecompression of the bones in an arthrodesis site prior to insertion ofretaining screws used to immobilize the foot bones after which thecompression disc can be removed.

Alternate embodiments also provide an improved arthrodesis nailoutrigger assembly adapted for guiding an arthrodesis tool into the footand leg bones applying an external compression disc and retaining screwsafter which the outrigger assembly can be removed.

Alternate embodiments also provide an arthrodesis nail outriggerassembly wherein the outrigger assembly can be adjustably rotated aroundan arthrodesis with respect to a stationary intramedullary nail device.

Alternate embodiments also provide an arthrodesis nail outriggerassembly having a cannulated nail mounting shaft arrangement to allowfor compression of a two-sectioned intramedullary nail device, resultingin a more tightly compressed and stable tibio-calcaneal arthrodesis.

Objects and advantages of embodiments of the invention will become clearupon review of the following detailed description in conjunction withthe appended drawings.

SUMMARY

In a preferred embodiment, an intramedullary fastener or nail isprovided, wherein the nail is formed in two sections that are adjustablyjoined together by an internal bolt member that can be rotated todecrease the total length of the combined nail. Accordingly, the deviceis capable of providing compression across an arthrodesis site in atibio-calcaneal arthrodesis nailing procedure. After the nail has beeninserted upwardly through holes drilled in the calcaneus and talus bonesand tibia, using an outrigger assembly the nail may be secured to thetibia. After this the outrigger assembly, in combination with acompression disc provided at the distal end of the nail, can rotate theinternal bolt member causing the distal or lower section of the nail andcompression disc to move upwardly toward the proximal or upper section,thus providing compression of the calcaneus and talus bones with thetibia so that any spaces between the joints are closed prior to securingthe bones in such position. In an alternate embodiment, at improvedoutrigger assembly is also provided that enables the outrigger handle tobe rotated and secured at ninety-degree angles with respect to thestationary intramedullary nail. The outrigger assembly providesstability and ease of use. The outrigger assembly can include acannulated nail mounting shaft that enables a compression driver to beinserted through the shaft upwardly into the nail to adjust the positionof the belt member and provide the desired amount of compression acrossthe arthrodesis site. In addition the amount of compression across thearthrodesis site can be adjusted at a later date via a minimallyinvasive procedure.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a partial cross-sectional view an embodiment of theintramedullary fixation device along its longitudinal axis in anuncompressed configuration.

FIG. 2 is a side view of an embodiment of the intramedullary fixationdevice as applied to an ankle joint in an uncompressed configuration.

FIG. 3 is a side view of the fixation device shown in FIG. 2 as appliedto an ankle joint in a fully compressed configuration.

FIG. 4A is a top view of an embodiment of a compression disc used withembodiments of the intramedullary fixation device.

FIG. 4B is a side view of embodiments of the intramedullary fixationdevice and the compression disc as applied to an ankle joint in anuncompressed configuration.

FIG. 5A is a side view of an embodiment of the proximal section of theintramedullary fixation device.

FIG. 5B is a cross-sectional view of the proximal section of anembodiment of the intramedullary fixation device of FIG. 5A.

FIG. 6A is a side view of an embodiment of the distal section of theintramedullary fixation device.

FIG. 6B is a view of an embodiment of the distal section of theintramedullary fixation device taken along the line B in FIG. 6A.

FIG. 6C is a view of an embodiment of the distal section of theintramedullary fixation device taken along the line C in FIG. 6A.

FIG. 7 is a side view of an embodiment of the compression bolt member ofthe intramedullary fixation device.

FIG. 8A is a side view of an embodiment of the bolt retainer member.

FIG. 8B is a cross-sectional view of the bolt retainer member shown inFIG. 8A.

FIG. 9 is a cross-sectional view of an embodiment of the intramedullaryfixation device as shown in FIG. 1 in a compressed configuration.

FIG. 10A is a side view of an embodiment of the intramedullary fixationdevice in an uncompressed configuration.

FIG. 10B is a side view of an alternative embodiment of theintramedullary fixation device.

FIG. 11 is a proximal end view of an embodiment of a section of theintramedullary fixation device.

FIG. 12 is a perspective view from the side of an embodiment of theoutrigger assembly and intramedullary fixation device.

FIG. 13 is a side view of an embodiment of the outrigger assembly andintramedullary fixation device.

FIG. 14 is a perspective view from the top of an embodiment of theoutrigger assembly and intramedullary fixation device.

FIG. 15 is an exploded view from the side of an embodiment of theoutrigger assembly.

FIG. 16 is an exploded view from the top of an embodiment of theoutrigger assembly.

FIG. 17 is a cross-sectional view from the side of an embodiment of theoutrigger assembly.

FIG. 18 is a side view of an embodiment of the intramedullary fixationdevice as applied to an fifth metatarsal fracture in an uncompressedconfiguration.

FIG. 19 is a side view of an embodiment of the intramedullary fixationdevice as applied to an long bone fracture in an uncompressedconfiguration.

FIG. 20 is a side view of an embodiment of the intramedullary fixationdevice as applied to subtalar joint fusion in an uncompressedconfiguration.

DETAILED DESCRIPTION

This description is not intended to be understood in a limiting sense,but to be embodiments of the invention presented solely for illustrationthereof, and by reference to, in connection with the followingdescription and the accompanying drawings, one skilled in the art may beadvised of advantages and construction of embodiments of the invention.Embodiments of the invention are intended to cover alternatives,modifications, and equivalents, which may be included within the spiritand scope of the invention as defined by the appended claims.

FIGS. 1-11 illustrate embodiments of the intramedullary fixation device,FIGS. 12-14 and 17 illustrate embodiments of the combinationintramedullary fixation device and outrigger assembly, and FIGS. 15-16illustrate embodiments of the outrigger assembly alone Referring to FIG.1, there is shown an embodiment of the intramedullary fixation device 12for stabilizing the position of and fusing together the tibia T (shinbone) relative to the talus A (adjoining ankle) and calcaneus C (heel)bones, and which is to be inserted through the bottom of the foot intothe medullary canal of the tibia. Intramedullary nail 12 is comprised oftwo main sections, referred to generally herein as proximal section 14and distal section 16. In addition, compression bolt 18 (see FIG. 7) canbe used to join proximal section 14 to distal section 16, and providethe required tension or compression of the ankle joint on installed, aswill also be described in detail below. In addition, alignment outriggerdevice 20 (FIG. 16) is provided, which can be used to precisely positionnail 12 in the tibia T and fixed to the talus A and calcaneus C bones.Also shown in FIG. 16 is compression driver 24, which is used to adjustcompression bolt 18.

Proximal 14 and distal 16 sections of intramedullary nail 12 generallyhave a rounded or circular shape, and are preferably made of surgicalstainless steel or surgical stainless titanium, and correspond generallyto the shape of the tibia medullary canal. Referring more particularlynow to FIG. 5A, proximal section 14 of nail 12 has a forward end 25 anda rearward tad 26, and is slightly tapered along its longitudinal axis23 from rearward end 26 to forward end 25, the outer surface of whichend is preferably smooth and rounded. Through-holes 28 can be formed inthe nail 12 extend perpendicular to longitudinal axis 23, and may bespaced apart in the shaft of proximal section 14 near forward end 25.Support screws 30 (see FIG. 1) can be passed through the holes 28 tosecure proximal section 14 of nail 12 to the tibia bone in position inthe tibia medullary canal. The screws 30 may have different lengths andsizes as required and known to those skilled in the art. The proximalsection 14 of the nail 12 may further include a bore 32 that extendsinwardly from the rearward end 26 of proximal section 14 along thelongitudinal axis 23, forming non-threaded sleeve area 34 adjacentrearward end 26, a short non threaded section 35 adjacent sleeve area 34and having a smaller diameter than sleeve area 34, with inwardlyextending circumferential bearing surface 37 formed between areas 34 and35. An internal screw threaded area 36 for receiving compression bolt 18can be formed by extending inwardly from short section 35. See alsoFIGS. 1 and 9. In addition, at least one alignment tab 38 is provided insleeve area 34.

As shown in FIG. 6A, distal section 16 of nail 12 has an upper end 40and a lower end 41, and is preferably slightly tapered from lower end 41to upper end 40 along its longitudinal axis 42. A plurality of holes 44can be situated in distal section 16 near lower end 41 extendingperpendicular to longitudinal axis 42 and spaced apart a predetermineddistance, for receiving screws 30 passed through the talus and calcaneusbones. Situated on the upper end 40 of distal section 16 is arm 46having a reduced outer diameter and being sized to be slidingly receivedin sleeve 34 of bore 32 in proximal section 14. A bore 48 extendsthrough distal section 16 from upper end 40 to lower end 41, which bore48 has a smaller diameter section 49 adjacent upper end 40 and arm 46,and a larger diameter section 50, with inwardly extending bearingsurface or end wall 51 between such sections. The bore 48 is alsovariable in FIGS. 1 and 9. Threads 52 are provided in the inner walls oflarger diameter section 50 of bore 48 adjacent lower end 41, while aplurality of spaced apart rectangular notches 54 are formed in lower end41 (See FIGS. 6C and 11). The upper end 40 of distal section 16 includestwo longitudinally-oriented notches 56. According to one embodiment,these notches are placed orthogonally with respect to each other and arealigned with or are orthogonal to the holes 44. The notches 56 aredesigned to mate with tab 38 in the rearward end of the proximal section14 of the nail 12 as shown FIG. 5B. By providing two notches 56 in theupper end 40 of the distal section 16, the distal section can beoriented such that its holes 28 are either aligned with the holes 44 inthe distal section 16, or placed orthogonal to holes 44. In this manner,the nail device 12 can be configured such that the nails can be applieduniformly in a medial-lateral (M-L) or anterior-posterior (A-P)direction, or distal nails and proximal nails can be alternated betweenan M-L, and A-P alignment (i.e., orthogonally), as shown in FIG. 10B.

Bore 48 is sized to receive compression bolt 18, shown in FIG. 7, whichbolt has a reduced diameter section 60 and a larger diameter headsection 62, forming an outwardly extending bearing surface 63 betweensections 60 and 62. Reduced diameter section 60 includes a threadedsection 64, a non-threaded shall section 66, a shallow notch 67 situatedbetween such sections, and head section 68. A socket 70 is provided inthe end surface of enlarged diameter section 62 to facilitate rotatingbolt 18 in either a clockwise or counterclockwise direction using adriving device 24 as described in more detail below. As shown in FIGS. 1and 9, head section 62 of compression bolt 18 is sired to be received inbore 50 of distal section 16 of nail 12, while at the same time reduceddiameter section 60 of bolt 18 is passed through bore sections 50, withthreaded section 64 extending outwardly through forward end 40 whileshaft section 66 remains in bore 49 in arm 46. When arm 46 is insertedin sleeve 34, male threaded section 64 can be received on the femalethreads in bore section 36, and when rotated on the threads arm 46 ispulled towards sleeve 34 until hearing surface 63 of head section 62engages against beating surface 51 in bore 50. Compression bolt 18 canbe adjustably secured to proximal section 14 by clip 72, shown in FIG.8, which clip is secured around the outer surface of bolt 18 in slot 67,to prevent threaded section 64 from being moved out of bore 32 pastsleeve section 34.

Embodiments of the invention also includes an improved outriggerassembly 20, shown alone in FIGS. 15-16, and with nail 12 attached inFIGS. 12-14 and 17. The outrigger assembly 20 is used to position andalign the intramedullary fixation device 12 while it is being insertedand secured in the patient's tibia medullary canal, and also while acompressive force is applied across the arthrodesis site. Outriggerassembly 20 includes an alignment beam 80 that can be detachably andadjustably secured to handle 82 in a slot 83 along one side edge ofhandle 82 so that the beam extends outwardly from the handle. A nailengaging shaft 84 can be secured to handle 82 in an aperture 85 alongthe opposite side edge of the handle, so that which nail 12 is engagedwith shaft 84, the nail 12 is spaced apart from and in parallel withbeam 80. Outrigger assembly 20 is preferably made of carbon fiber, whichis radiolucent and thus does not appear in x-rays, although othermaterials such as surgical stainless steel may be used.

Beam 80 can be secured in slot 83 by two different locking mechanisms onopposite sides of the slot. The first of these is a threaded pin 86which is threadably secured in an aperture 87 in handle 82. A aperture87 extends laterally between the outer side surface of handle 82 andslot 83. Thus, when pin 86 is inserted and tightened in aperture 87 withbeam 80 in slot 83, its forward end extends through aperture 87 andpresses against the side surface of beam 80, preferably in one ofseveral notches 88 (see FIG. 17) in the corresponding side surface ofbeam 80, to hold it in place in slot 83. The second locking mechanism ispinstop 89, which engages with beam 80 provided on the opposite side ofslot 83 in handle 82. As shown in the cross sectional view in FIG. 17,an angled aperture 90 is provided in handle 82 having a larger diameterend section 92, a reduced diameter center section 94, and second reduceddiameter section 9 terminating at slot 83. In addition, a transverseslot 98 can be cut a out in handle 82 extending through reduced diametercenter section 94. Aperture 90 can receive a lock shaft 100 having ahead section 102, a non-threaded shaft section 104, a threaded shaftsection 106, and a forward non-threaded pin section 108. Head section102 is sized to be received in end section 92 of aperture 90, shaftsections 104 and 106 are sized to be received in center section 94 ofaperture 90, and pin section 108 is sized to be received in section 96of aperture 90. Lock spring 110 is placed around non-threaded shaftsection 104, while adjustor knob 112 is secured over threaded shaftsection 106 in transverse slot 98, such that taming knob 112 causes lockshaft 100 to move either forwardly or rearwardly in aperture 90, withthe forward end of pin section 108 extending into one of severalsimilarly angle apertures 114 in beam 80, thereby locking beam 80 inplace. Notches 116 aligned with apertures 114 are also provided in beam80, which when aligned properly with handle 82 engage teeth 117 on theinner surface of slot 83 adjacent second reduced diameter section 96 ofaperture 90. Thus, the tension on beam 80 can be adjusted on one side byrotating knob 112, and on the other side using threaded pin 86 to ensurethat such tension is generally equal and further than beam 80 is lockedin place.

The intramedullary fixation device mounting shaft 84 may include abottom section 118 that is generally square or rectangular and fits inaperture 85 in handle 82. The mounting shaft 84 also includes a slidelock receiving section 120, adjacent to bottom section 118, a shortconical section 122 adjacent to slide lock receiving section 120, asecond short enlarged diameter section 124 adjacent conical section 122,and a shaft section 126 for engaging with nail 12. A Cavity 128 mayextend through the nail mounting shaft 84, and alignment tabs 130 thatengage with notches 54 in the outer end 41 of distal section 16 of nail12. The alignment tabs 130 also engaged with notches 154 on compressiondisc 150, shown in FIG. 4. The alignment tabs 130 can be provided on theouter end of shaft section 126. Another slot 134 and associated notch135 (see FIG. 17) are provided in the side surface of handle 82 adjacentaperture 85, in which slide lock device 136 can be inserted. Slide lockdevice 136 has a head or button section 138, a rectangular shaft section140 having a lateral through-hole 142, and a pin section 144 extendingforwardly from shaft section 140, around which pin 144 coil spring 146may be secured. When bottom section 118 of nail mounting shaft 84 isinserted in aperture 85, the slide lock device 136 can be inserted inaperture 134 unfit lateral hole 142 is aligned with aperture 85. Bottomsection 118 may therefore be passed through lateral hole 142, and slidelock receiving section 120, which section has a width that is slightlygreater than the width of shaft section 140, is aligned in hole 142.Slide lock device 136 can serve as a position stop locking device, asspring 146 causes shaft section 140 to press against the side surface ofslide lock receiving section 120, thereby locking nail receiving shaft84 in place secured to handle 82. When button 138 on slide lock device136 is pressed inwardly, shaft 84 is released and outrigger assembly 20can be swiveled or rotated with respect to shaft 84 and nail 12 in athree hundred sixty degree range around shaft 84 and nail 12. Theoutrigger assembly 20 can also be stopped and locked at ninety degreeintervals. Such unique feature enables the outrigger assembly to berotated to different positions or angles around a patient's legs asdesired, with the nail 12 remaining stationary or fixed to the patient'stibia. This may be desired in some cases where the outrigger assembly isin the surgeon's way while another step or task is being performed, andallows the assembly to be moved out of the way and then back again aftera task has been completed, or where the outrigger assembly must be movedin order to complete the operation.

Nail 12 can be secured to outrigger assembly 20 as follows. Thealignment between the proximal section 14 and distal section 16 ineither the M-L or A-P orientation is determined by the surgeon and thenotches 56 are mated with tab 38 for the desired alignment. To changealignment, the compression driver 24 facilitates the removal of theproximal section 14 from bolt 18 via socket 70. The proximal section 14,using notches 56 and tab 38, can be re-oriented and the compressiondriver 24 tightens the proximal section back on bolt 18 via socket 70.The notches 54 in the lower end 41 of distal section 16 ofintramedullary fixation device or nail assembly 12 can be aligned in thedesired position with tabs 130 on the outer end of shaft section 12$ ofnail mounting shaft 84. In addition, compression disc 150, shown in FIG.4A, can be positioned between lower end 41 of nail 12 and tabs 130 sothat it will be held between the lower end of the nail and forward endof shaft section 126. As shown in FIG. 4A, disc 150 has an aperture 152through its center area, to accommodate shaft section 126 passingthrough such aperture. The purpose of disc 150 is to prevent the lowerend of nail 12 from pulling upwardly into the calcaneus or heel bonewhen the bolt 18 is rotated to bring the distal section 16 of nail 12upwardly to proximal section 14. Rather, with compression disc 150abutting against the bottom surface of the patient's heel, the upwardmovement of distal section 16 will cause the spaces between the lowerend of the tibia and top surface of the talus, as well as between thebottom surface of the talus and top surface of the calcaneus, to shrinkand eventually be eliminated, as shown in FIGS. 2 and 3, and resultingin a desirably compressed ankle joint, In a preferred embodiment, thecompression disc 150 is placed against the heel bone internal to thebody. In an alternate embodiment, the compression disc 150 is placedagainst the heel bone external to the body.

Once alignment tabs 130 on the outer end of shaft 84 have been engagedwith notches 54 on the lower end 41 of nail 12, with compression disc150 inserted in-between, then nail attachment device 160 can be used tosecure nail 12 to shaft 84. As illustrated in FIG. 17, device 160 maycomprise a knob 162 attached to one end of an elongated shaft 164 havingmale threads 166 on its opposite end. Shaft 164 is sized to be slidablyreceived in cavity 128 in nail mounting shaft 84. In addition, a cavity168 extends through shaft 164 from end to end. Male threads 166 can beengaged with female threads 52 on the lower end of distal section 16 offixation device 12, thus causing nail 12 to be tightly secured tomounting shaft. 84. Note also that compression bolt 18 can bepre-positioned in proximal and distal sections 14 and 16, so that thenail 12 is in an uncompressed state. After a hole has been is drilledupwardly through the bottom of the calcaneal bone C, talus A (if not soeroded or degraded that it no longer separates the tibia from thecalcaneal bone) and into the medullary canal, the tibea T and cleanedout appropriately using techniques known to those skilled in the art,the forward end 25 of proximal section 14 of nail 12 can be insertedupwardly into such hole into the tibia, also in the known manner. Screwholes 170 are provided in the distal end of beam 80, which during use ofoutrigger assembly 20, can be aligned with holes 28 in proximal section14 of nail 12. Similarly, similarly screw holes 172 in beam 80 can bealigned with holes 44 in distal section 16 of nail 12. Use of theoutrigger assembly 20 with beam 80 assists the positioning and alignmentof screws 30 with the tibia, talus, and calcaneus during insertion.Using outrigger assembly 20, holes can be then drilled into the tibia,which holes are aligned with holes 28 in nail 12, and been screws 30 canbe inserted in such holes to secure proximal section 14 of nail 12 inposition in the tibia. Then, compression driver 24 can be used rotatebolt 18, which movement causes distal section 16 to move upwardlytowards proximal section 14. As shown in FIG. 16, compression driver 24may include a handle section 180, a shaft or blade section 182 and a tip184 which is designed to match and be received in socket 70 in the endof bolt 18. Blade section 182 is sized to glidingly fit through cavity168 in nail attachment device 160, and is long enough so that tip 184can be engaged with socket 70 in bolt 18. Bolt 18 can be turned so thatthreaded shaft section 64 is moved upwardly into threaded section 36 ofproximal section 14 of nail 12, thus causing distal section 16 to slowlymove upwardly toward proximal section 14. As indicated above andillustrated in FIGS. 3 and 4B, such movement causes the calcaneus andtalus bones to also be forced to moved upwardly toward the lower end ofthe tibia. Eventually, by continuing to rotate driver 24 to turn bolt18, an adequate amount of compression of the ankle joint can beaccomplished, after which driver 24 may be removed from cavity 168 inmounting abaft 84. Then, the surgeon may secure the talus and calcaneusbones in such a compressed position against the lower end of the tibiaby drilling the appropriate holes in the talus and calcaneus throughapertures 172 in beam 80 of outrigger assembly 20, and the insertingscrews through such holes and into holes 44 in distal section 16 of nail12. Once properly secured, nail attachment device 160 can be removedfrom the lower end 41 of nail 12, and compression plate 150 can also becoincidently removed. Preferably a suitable screw threaded cap can beplaced over the lower end of nail 12 on threads 52.

FIGS. 2-3 are exemplary embodiments of uses for the intramedullaryfixation device for use in ankle arthrodesis. FIG. 2 is a side view ofthe nail 12 in a non-compressed state in position within the tibia (T),talus (A) and calcaneus (C) bones. In FIG. 3 the nail 12 of FIG. 2 is ina compressed state. FIG. 4B is another view the nail of FIG. 2 in anon-compressed state along with the compression disc 150 being placedagainst the calcaneus hone. FIGS. 2 and 4 also show the direction ofcompression being applied.

FIGS. 18-20 are exemplary alternate embodiments of uses for theintramedullary fixation device. FIG. 18 is a side view of theintramedullary fixation device as applied to a fifth metatarsal fracturein an uncompressed configuration. The proximal portion 14 of nail 12 canhe secured to a first portion of a metatarsal bone and the distalportion 16 of nail 12 can be secured to a second portion of themetatarsal bone. The direction of compression is also shown. Acompression disc 150 can also be used and placed to provide acompressive force on the bones during compression of the nail 12 butprior to the distal portion 16 being affixed to the second portion ofthe metatarsal bone. The compression disc 150 may be placed internal orexternal to the body.

FIG. 19 is a side view of the intramedullary fixation device as appliedto a long bone fracture in an uncompressed configuration. The proximalportion 14 of nail 12 is secured to a first portion of a long bone andthe distal portion 16 of nail 12 is secured to a second portion of thelong bone. The direction of compression is also shown. The long bone maybe any bone having a fracture that would benefit from the compressiveforces of nail 12 being applied thereupon. Examples of a long boneinclude the tibia and femur. A compression disc 150 can also be used andplaced to provide a compressive force on the bones during compression ofthe nail 12 but prior to the distal portion 16 being affixed to thesecond portion of the long bone. The compression disc 150 may be placedinternal or external to the body.

FIG. 20 is a side view of the intramedullary fixation device as appliedto subtalar joint fusion in an uncompressed configuration. The proximalportion 14 of nail 12 is secured to the talus (A) and the distal portion16 of nail 12 is secured to the calcaneus (C) bones. The direction ofcompression is also shown. A compression disc 150 can also be used andplaced to provide a compressive force on the bones during compression ofthe nail 12 but prior to the distal portion 16 being affixed to thesecond portion of the calcaneus bone. The compression disc 150 may beplaced internal or external to the body.

While many embodiments of the present invention have been described atsome length and with some particularity with respect to the severaldescribed embodiments, it is not intended that it should be limited toany such particulars or embodiments or any particular embodiment, but itis to be construed with references to the appended claims so as toprovide the broadest possible interpretation of such claims in view ofthe prior art and, therefore, to effectively encompass the intendedscope of the invention.

1.-25. (canceled)
 26. A method of stabilizing one or more bones with anintramedullary fixation device, the method comprising: providing anintramedullary fixation device comprising: a distal section having areduced diameter arm on its upper end and an internal bore having afirst section and a second section, the second section having a smallerdiameter than the first section; a proximal section, the proximalsection having an internal bore in its rearward end, the bore having athreaded area and a non threaded area, the non threaded area being sizedto slidingly receive the reduced diameter arm; a connecting member foradjustably securing the distal and proximal sections end to end along alongitudinal axis, the forward end of the connecting member beingthreadably received in the threaded area of the proximal sectioninternal bore, and the rearward end being sized to be received in thefirst section of the internal bore is the distal section; means forsecuring the proximal section to a first bone; and means for securingthe distal section to a least one different bone, wherein the connectingmember is rotated to provide compression across a bone arthrodesis siteto be stabilized and fused; positioning the intramedullary fixationdevice with respect to the one or more bones; securing the proximal endof the intramedullary fixation device to a first bone location; securingthe distal end of the intramedullary fixation device to a second bonelocation; and applying a compression force across the first and secondbone locations.
 27. The method of claim 26, wherein the first and secondbone locations are on the same bone.
 28. The method of claim 26, whereinthe first and second bone locations are on different bones.
 29. Themethod of claim 26, wherein the one or more bones is a long bone. 30.The method of claim 29, wherein the long bone is a femur.
 31. The methodof claim 29, wherein the long bone is a tibia.
 32. The method of claim29, wherein the long bone is a fibula.
 33. The method of claim 29,wherein the long bone is a metatarsus.